ACTION: CODED BY: DATE: GROUP MEDICAL and 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting your employment status under 'EMPLOYED BY'. Choose from options like UN Secretariat, UNICEF, or specify another organization.
3. Fill in your personal details including Last Name, First Name, Date of Birth, and Sex. Ensure accuracy as this information is crucial for your insurance records.
4. Provide your Mailing Address. Remember to register this address with your Human Resources Office to receive important communications.
5. Indicate your Office Room Number and Telephone Number for contact purposes.
6. Select the Type of Contract you hold and provide the relevant dates if applicable.
7. Complete sections regarding Life Insurance preferences and Medical Coverage selections by checking appropriate boxes.
8. List any dependents under the specified sections, ensuring all necessary details are filled out accurately.
9. Review all entries for correctness before signing and dating the form at the bottom.

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